The aesthetic outcome of breast augmentation plastic surgery depends on many factors. The choice of implantation pocket and the method of implantation are of great importance. Chest aesthetics after breast augmentation is influenced by the patient’s individual baseline data, including the shape of the chest and mammary glands, the condition of the skin, and the thickness of the subcutaneous fat layer. These and other anatomical features are taken into account when selecting the profile, base width, size, and shape of the endoprosthesis. An important criterion for a successful operation is to achieve a stable result that will delight a woman for many years.
The publication discusses the main methods of breast augmentation - the types of surgical access, the types of anatomical pockets needed to insert an implant, the advantages and disadvantages of different methods of mammoplasty. You can learn how to recover properly after surgery, what can and cannot be done during the rehabilitation period.
Signs for breast augmentation with implants
Breast augmentation surgery is performed with implants for aesthetic reasons. The main indication for augmentation mammoplasty is the patient’s desire to improve the aesthetics of the breast by increasing its size and modeling the shape. During surgery, the disadvantages caused by the complex deformation of the nipple areola (stretching of the areola, deformation) and the prolapse of the glands after feeding the baby or due to age-related changes can also be eliminated.
The following problems cause a plastic surgeon to contact:
- Deterioration of breast aesthetics after pregnancy and lactation.
- Breast shape change as a result of evolutionary (aging) processes.
- Congenital hypoplasia or amastia of the mammary glands.
- Asymmetry, both innate and acquired.
- Tubular breast.
- Mastoptosis with signs of mammary hypotrophy.
- A woman's dissatisfaction with the shape or size of her chest.
Breast augmentation with implants is also performed in patients who have undergone radical breast surgery as part of the treatment of malignancies. Reconstructive augmentation mammoplasty allows the creation of natural and aesthetic breasts without increasing the risk of developing tumor processes.
What unique features are considered before the operation?
The tactics of surgical correction are determined by the individual characteristics of the patient. Yes, it is always possible to insert a large implant, but such a step does not always lead to the desired result - a change in natural and harmonious appearance.
The following factors influence the choice of shape, profile and size of the endoprosthesis, as well as the way the implant pocket and implant are placed:
- The age of the woman.
- The original shape and size of the mammary glands.
- Height and width of the chest.
- Severity of subcutaneous fat.
- Flexibility of the integumental tissues of the mammary glands.
- The width of the interthoracic space.
- Signs of chest ptosis (drooping).
The tactics of augmentation mammoplasty are also influenced by whether a woman plans to give birth and breastfeed her baby in the future. The choice of access will also take into account the need for complex plastic surgery of the nipple-areola, which may be required to achieve optimal aesthetic results.
Methods for implant placement
Taking into account the above unique features of the anatomy and other factors, the plastic surgeon chooses one of three methods of breast augmentation (type of surgical access):
- Areolar (breast augmentation "through the areola").
The features, advantages and disadvantages of each method of augmentation mammoplasty are detailed below.
With an areolar or periareolar approach, the plastic surgeon inserts implants through an incision that extends to the periphery of the pigmented area of the areola. The main advantage of such a surgical approach is the invisibility of the scars. The scar is located on the border of light and dark skin, so it’s pretty hard to spot.
Periareolar breast augmentation has other benefits in addition to minimal postoperative scar severity:
- During the operation, it is possible to perform complex plastics of the nipple-areola. In some cases, it is difficult to achieve optimal breast aesthetics without correcting the size and shape of the SAH, and this advantage of periareolar access may play a crucial role.
- The periareolar approach eliminates the risk of damage to the afferent (sensory) nerve fibers that reach the SAH in the chest area. Due to this advantage, the areolar mammoplasty method allows the complete preservation of the sensitivity of the nipple and areola.
- You can correct the initial stage of mastoptosis by enlarging your chest.
Despite the benefits of periareolar access listed above, the technique is not recommended for all women. In particular, this method of implant placement is not recommended for girls who are giving birth and breastfeeding children. This is explained by the risk of damage to the milk ducts during surgery, which will affect lactation function.
The periareolar approach does not provide a complete picture of all implant pockets, which limits the size of the implant. This method is well suited for patients who want to place a small endoprosthesis and slightly enlarge their breasts. In a situation where a woman wants to add 2-3 sizes to her breast, it is preferable to use a submammary or axillary approach.
In the submammary approach, endoprostheses are placed through horizontal incisions that pass under the breast through the natural skin fold. Postoperative scars are significantly accentuated when using this method of implants, but are hidden in the folds of the skin. The scars are visible lying down and covered by the lower pole of the breast while standing.
The main advantage of the submammary approach is that it sees the surgical area very well. For the plastic surgeon, this is the simplest type of mammoplasty, as full access to all implant pockets is provided and absolutely symmetrical implant placement is easy. Thanks to this function, it is possible to install large endoprostheses.
An additional benefit of the submammal breast augmentation technique is that there is no risk of damaging the milk ducts. After surgery, lactation function is maintained, allowing this method for patients who are planning a future pregnancy and breastfeeding.
The submammar method of implant placement has no drawbacks. The main disadvantage of the technique for many patients of plastic surgeons is a pronounced and rather long scar that runs in a fold under the breast. Its disadvantage is the risk of damage to the afferent nerves innervating SAH. If the nerve is cut off during surgery, the sensitivity of the nipple and areola deteriorates.
The use of submammary access does not allow SAH plastic surgery to be performed through an incision at the same time as augmentation mammoplasty. In addition, women who have initial signs of a bust (mastoptosis) often seek the help of a plastic surgeon. If the periareolar approach makes it possible to eliminate age-related manifestations, it is impossible to correct mastoptosis concomitantly with breast augmentation using the submammary approach.
In the axillary approach, breast augmentation is performed through incisions in the axillary fossa. The main advantage of the technique is that the scars run away from the mammary glands and do not affect their aesthetic perception. On the other hand, scars can be detected and this can be a problem if a woman is wearing a revealing dress. For example, scars are clearly visible during sports, especially in posture, with arms raised.
Nevertheless, the axillary approach is considered the "gold standard" in augmentation mammoplasty. The operation is performed under the control of fiber optic equipment (endoscope) that allows the plastic surgeon access to all implant pockets. There is no risk of damage to nerve strains. There is also no risk of dissection of the milk ducts, which allows girls planning to become pregnant with this method of implant placement. There are no restrictions on the size of the endoprosthesis - the axillary-type access allows the placement of implants of any volume, shape and profile.
The disadvantages of the method of axillary breast augmentation are that the plastic surgeon does not have the opportunity to correct the consequences of mammary gland prolapse or to perform complex plastic surgery on the nipple-areola. Therefore, the axillary approach is primarily used to model breast size when there are no concomitant aesthetic problems that require surgical correction.
Criteria for selecting surgical access
In clinical practice, plastic surgeons use a number of criteria to select a surgical approach to breast augmentation. One of the main criteria is the woman’s age and future pregnancy plan. If the patient is planning to have a child, it is advisable to deny periareolar access. Entry into the armpit or armpit is preferred.
If a woman is not planning to give birth, any of the types of surgical access discussed earlier can be used. In situations where areola plastic surgery is required to improve the aesthetics of the bust while enlarging it, periareolar access is preferred. The same method of implant placement is more appropriate for patients with initial signs of mastoptosis.
For patients who want to enlarge their breasts to multiple sizes, the plastic surgeon may recommend the submammary or axillary method. The optimal choice in this situation is the growth of the mammary glands through the axillary fossa, but the aesthetic desires of the woman are also taken into account. If you express a desire to hide the scar in a natural wrinkle under the breast, the submammary approach is chosen.
Select a pocket for implant placement
The next aspect of augmentation mammoplasty is related to the choice of anatomical area in which the implants will be placed.
The implantation pocket can be placed:
- under the mammary gland (subglandular placement);
- under the pectoralis muscle (submuscular location);
- partly under the gland, partly under the muscle (combined version).
Subglandular placement.The implant is placed in the anatomical space below the gland. The most superficial pocket is separated from the body surface only by the integumental tissues and mammary glands, and therefore, due to its function, it is not recommended to use it if the breast needs to be enlarged in several sizes. A large endoprosthesis is visually identifiable. In addition, there is an increased risk of gradual deformation, an aesthetic complication in which a kind of "step" is formed over the upper edge of the implant.
Sublandial placement of the endoprosthesis increases the risk of other aesthetic complications, especially the appearance of deformation of the integumental tissues in the form of "waves" or "waves" above the mammary gland. With the development of capsular contracture, the deterioration of the aesthetics of the breast is also more pronounced with the superficial placement of the implant.
Another feature of this type of placement is that the endoprosthesis and mammary glands are supported only by Cooper ligaments - connective tissue structures - whose elasticity decreases with age. Because of this, subglandular implantation increases the risk of developing mastoptosis, especially in women with initially large breasts.
Submuscular placement.By placing the implant under the pectoralis major muscle, problems with subglandular placement can be avoided. There is less risk of capsule contracture and the appearance of breast deformity above the breast in the form of "waves" and "waves. " The endoprosthesis is securely fastened by the muscles and does not increase the likelihood of developing mastoptosis.
But there is a downside to placing the implant under a muscle.
First, girls who are active in sports have an increased risk of implant rotation or displacement. If teardrop-shaped implants have been used to enlarge the breast, rotation (rotation) can lead to breast deformity that can only be corrected during a second surgery.
Second, with subcutaneous placement, the extent of tissue damage during surgery increases. Because of this, recovery is slower and the rehabilitation period is extended - you have to wear compression underwear and adhere to all restrictions for a longer period of time.
Combined placement.The best solution is a combined placement in which the upper segment of the endoprosthesis is under the muscle and the lower pole is under the gland. This arrangement eliminates the risk of stepped deformation. The risk of implant rotation and displacement, capsular contracture, and other aesthetic complications is lower. Healing is faster and the rehabilitation period is shorter.
Types of implants
Breast augmentation is done with implants from the world's leading manufacturers. Endoprostheses are made of medical silicone with a high degree of cohesion and variable density. The silicone is covered with an elastomeric shell, which eliminates the possibility of gel diffusion. The outer capsule is represented by a porous shell, the special texture of which facilitates the integration of the implant into living tissues and its reliable fixation. Due to the porous membrane, the risk of fibrous-capsular contracture is reduced.
There are hundreds of types of implants from each manufacturer, which differ in the following characteristics:
- Shape: The implant can be anatomical (teardrop) or round.
- Base width: the horizontal size of the lower pole of the endoprosthesis.
- Profile: Height of endoprosthesis.
- Size: volume.
The choice of implant is determined by the wishes and the initial data of the patient - the unique characteristics of the structure of the chest and mammary glands. For example, low-profile, broad-based anatomical implants are better suited for girls with a pronounced interthoracic gap. Round, full-profile implants that visually enlarge the upper pole of the breast are more suitable for women who want to focus on the area of décolletage.
Preparing for breast augmentation with implants
The preparation for breast plastic surgery can be divided into two stages - diagnostic and aesthetic. The purpose of the aesthetic preparation phase is to select the ideal implant and determine the tactics of the surgical procedure. Based on the results of computer modeling and analysis of the patient’s initial data, the surgeon chooses a method to install the endoprosthesis and place it with an anatomical pocket.
The goal of the diagnostic phase is to minimize the risks of operation and anesthesia and to rule out contraindications to surgery. All women undergo a comprehensive diagnosis before breast augmentation, including an expanded list of instrumental and laboratory methods. Mammography is prescribed without failure in consultation with a gynecologist and mammologist.
A woman should stop taking certain medications, such as hormonal contraceptives and anticoagulants, a few weeks before augmentation mammoplasty. It is necessary to exclude anti-inflammatory and analgesic drugs from the NSAID group as they slow down blood clotting. There is also a need to stop alcoholic beverages and smoking cessation, as ethanol and nicotine slow down regeneration processes and negatively affect the rate of recovery after mammoplasty.
Rehabilitation after mammoplasty
The early postoperative period is accompanied by symptoms typical of all surgeries - swelling, pain and bruising in the area of the surgical wound, fever, general malaise. These symptoms are the body's normal reaction to tissue breakdown. Coping with the difficulties of this period will help with medications prescribed by the plastic surgeon - anti-inflammatory, exudative and painkillers. To prevent infectious complications, your doctor will prescribe a short course of antibiotics.
A feature of the post-mammoplasty rehabilitation period is that a compression bra must be worn at all times. They sew sewn elastic underwear before the operation. It must be worn at all times, it can only be removed during hygienic procedures. As far as body hygiene is concerned, the first 7-10 days after breast augmentation should be limited to wet rubbing, no showering is allowed.
Sleep after surgery is only possible on your back. You can sleep on your side for 10-14 days, but you can’t get on your stomach yet. You can't go dancing or playing sports. The ban on physical activity, including domestic activities, is valid for 4 weeks; exercise and certain types of cardio training for 3 months (or until specifically approved by the plastic surgeon) are contraindicated.
Do not sunbathe in direct sunlight or solarium during the entire recovery period. You can’t go to a sauna or bath, you can’t take a hot bath at home. Alcohol and smoking are contraindicated. Compression underwear should be taken off from the second month onwards, but a bra with a wide strap and a wide belt that supports your chest well should be worn throughout the year.